Fingertip Reconstruction with Perionychial Flaps

Kwan Chul Tark; Hee Young Lee; Ryun Lee; Ji Hyun Kim; Dong Chul Kim

doi:10.12790/jkssh.2016.21.2.77

Journal List > J Korean Soc Surg Hand > v.21(2) > 1106551

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Tark, Lee, Lee, Kim, and Kim: Fingertip Reconstruction with Perionychial Flaps

ORIGINAL ARTICLE

J Korean Soc Surg Hand 2016;21(2):77-83.

Published online: 11 June 2016

DOI: https://doi.org/10.12790/jkssh.2016.21.2.77

Fingertip Reconstruction with Perionychial Flaps

Kwan Chul Tark, Hee Young Lee, Ryun Lee, Ji Hyun Kim, Dong Chul Kim

Department of Plastic and Reconstructive Surgery, Bundang Jesaeng Hospital, Seongnam, Korea

Correspondence to: Kwan Chul Tark, Department of Plastic and Reconstructive Surgery, Bundang Jesaeng Hospital, 20 Seohyeon-ro 180beon-gil, Bundang-gu, Seongnam 13590, Korea, TEL: +82-31-779-0281, FAX: +82-31-779-0164, E-mail: only1jihyun@hanmail.net

Received 28 March 201611 May 2016 Accepted 17 May 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

Out of nail components, nail plate, nail fold, paronychium, hyponychium, nail bed, and matrices are referred to as the perionychium. The authors report the outcomes of perionychial flap for reconstruction of fingertip injuries with nail bed injuries.

Methods:

We performed 8 cases of perionychial flap for fingertip injuries with nail bed injuries between January 2012 and December 2015, and analyzed the outcomes of the reconstruction surgery. The patients evaluated the aesthetic results on a four-point scale, and we measured and evaluated the ratio of axis length of the nail plate compared with collateral side of normal nail plate.

Results:

The mean follow up period was 8.4 months, and range of motion of distal interphalangeal joints and sensation of the reconstructed pulp were normal in all patients. After reconstructive surgery the nail plates regrew up to 80% in average compared to the normal side, and the satisfactory score were good to excellent as 3.8 point in average.

Conclusion:

The reconstruction of fingertip injuries with nail bed injuries using perionychial flap including paronychium and hyponychium is safe and easy procedure and aesthetic outcomes were excellent. The authors consider the perionychial flap as a useful technique for fingertip reconstruction.

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Keywords: Nail, Fingertip reconstruction, Perionychial flap

REFERENCES

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Fig. 1.

Schematic design of perionychial flap for finger tip reconstruction. (A) Preoperative view. (B) After extraction of remaining nail, crushed soft tissues were minimally debrided. Comminuted fracture segments of the fingertip were also removed. Hyponychial, paronychial flap was elevated, and a triangular nail bed was excised to provide an ideal rotation of the hyponychial or paronychial flap. (C) Nail bed wounds were sutured with 5-0 Vicryl and 5-0 Nylon sutures.

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Fig. 2.

(A) A patient of 58-year-old man sustained a punch injury at a left index finger tip. (B) The radiographic image of the patient shows a fracture with a partial bone defect of the distal phalanx. (C) Reconstruction with a perionychial flap. (D) Postoperative 12 months view.

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Fig. 3.

(A) A patient of 56-year-old man suffered from crushing injury at right thumb. (B) The radiographic image of the patient shows a comminuted fracture of the distal phalanx. (C) Reconstruction with a perionychial flap. (D) Postoperative 10 months view.

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Table 1.

Summary of the patients and postoperative follow-up

Case	Sex	Age (yr)	Location	Injury pattern	Follow-up period (mo)	Ratio (%)	Result (scale)	Satisfaction score
1	Male	40	Left index	Amputation	12	80	Good (3)	Excellent (4)
2	Female	30	Left index	Amputation	12	85	Excellent (4)	Excellent (4)
3	Female	29	Right index	Crushing	12	85	Excellent (4)	Excellent (4)
4	Male	56	Right thumb	Crushing	10	80	Good (3)	Good (3)
5	Male	68	Right ring	Amputation	4	85	Good (3)	Excellent (4)
6	Male	65	Left little	Amputation	3	70	Good (3)	Good (3)
7	Male	44	Left thumb	Amputation	2	65	Excellent (4)	Excellent (4)
8	Male	58	Left index	Punch	12	90	Excellent (4)	Excellent (4)
Mean		48.8			8.4	80.0	3.4	3.8

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